b'PACEP SCIENTIFIC ASSEMBLY 2025 CPC HIGHLIGHTWhat is the Diagnosis?A special thank you to Alexandra Amaducci, DO for organizing this years CPC competition during the PACEP25 Scientific Assembly and to Alina Broton, DO from Jefferson Einstein Residency for submitting the case and being the resident presenter. An additional thank you to Martha Barrett, MD from Wellspan York for being the attending discussant.65 year old male presented to the ED for altered mental status. EMS reports they were called after the wife found him on the ground, on his back, covered in vomit. The wife reported that the patient was previously notCPC CASE answering questions appropriately and his speech was different. The wifeSTUDY also reported that he drank a bottle of liquid that he thought was water but tasted sweet, she is not sure what it is. Medics arrived and patient wasTHE CASEminimally arousable. He had one episode of vomiting en route. On arrival, patient has slurred speech, is confused and unable to provide much history.Past Medical History: hypertension Neuro: A & O x 2, CN II- XII intact, Troponin 3 Vital Signs: HR 95 bpm, RR 18reflexes 2+ throughout. AGAP: 12breaths per minute, SpO2 96% onSensation: diminished sensation Bicarb: 21 RA, BP 134/75 mmHg, Temp 36.8 Cleft UE and LECreatinine 1.16Physical Exam: Coordination: FTN left has high pH 7.39 LFTs WNLGeneral: A & O x 2, covered in vomit,amplitude perpendicular tremor that worsens when approachingEKG: Normal sinus rhythm with no NAD, atraumatic ischemic findingsthe target, unable to reach target Eyes: EOMI, sclera anictericwith outstretched arm, andPertinent Imaging: CT HeadCardiac: regular rate and rhythm, nomisses nose on most attempts, murmur. No peripheral edema FTN on right intactSkin: Warm, dry, no rashes or lesionsGait: unsteadyRespiratory: lungs CTAB, breath NIH score: 10sounds present bilaterally, noPertinent Labs: tachypnea, speaking in full sentencesCBC unremarkable UDS: negativeMSK: no gross deformities noted. Etoh: 10Decreased strength in the left upper Acetaminophone 3extremity and lower extremity. Salicylate 5Normal motor strength in right UE Ammonia: 41.8and LE.Lactate: 2.4What test will make the diagnosis?What is the final diagnosis?see conclusion on page 3128 PACEP News | Fall 2025'